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C-Reactive Protein and Long-Term Risk of Death in Patients with Myocardial Infarction
Julie Borchsenius1,2, Kristian H Kragholm3, Deepak L Bhatt4
1Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Insights
Elevated C-reactive protein (CRP) levels after myocardial infarction predict a higher risk of death and heart failure. This study confirms CRP
Area of Science:
- Cardiology
- Biomarkers
- Public Health
Background:
- The long-term prognostic significance of standard C-reactive protein (CRP) in myocardial infarction (MI) patients remains unclear.
- Assessing CRP's role in predicting outcomes post-MI is crucial for risk stratification and management.
Purpose of the Study:
- To investigate the long-term prognostic value of baseline C-reactive protein (CRP) levels in patients following a first myocardial infarction.
- To determine the association between CRP quartiles and the risk of all-cause mortality and new-onset heart failure.
Main Methods:
- Utilized Danish nationwide registries to identify 29,035 patients diagnosed with myocardial infarction between 2013-2020.
- Measured C-reactive protein (CRP) levels within 24 hours of hospitalization.
- Employed multivariable Cox regression with average treatment effect modeling to assess risks for death and heart failure across CRP quartiles, adjusting for key clinical factors.
Main Results:
- Higher C-reactive protein (CRP) concentrations were significantly associated with increased risks of death and heart failure.
- Patients in the highest CRP quartile (>=12 mg/l) exhibited the highest standardized absolute risks for death at both 0-30 and 31-365 days.
- A stepwise increase in relative risk for death and heart failure was observed with rising CRP levels.
Conclusions:
- Elevated C-reactive protein (CRP) levels are a significant independent predictor of long-term mortality and incident heart failure in myocardial infarction survivors.
- CRP measurement provides valuable prognostic information, aiding in the risk stratification of patients post-myocardial infarction.
Introduction:
The long-term prognostic value of standard C-reactive protein (CRP) in patients with myocardial infarction is unknown.
Methods:
Using Danish nationwide registries, we identified patients with a diagnosis of myocardial infarction from 2013 through 2020, who had a CRP measurement ≤24 h of index hospitalization. The primary outcome was death from any cause, and the secondary outcome was hospitalization or outpatient contact for new-onset heart failure. Absolute and relative risks for outcomes according to CRP quartiles at days 0-30 and 31-365 were calculated using multivariable Cox regression with average treatment effect modeling, adjusted for demographics and clinical features, including high-sensitivity troponin concentrations.
Results:
A total of 29,035 patients with myocardial infarction were included. Median CRP was 4 mg/L, and quartile intervals were quartile 1: <2.9 mg/L, quartile 2: 2.9 to <4 mg/L, quartile 3: 4 to <12 mg/L, and quartile 4: ≥12 mg/L. At 0-30 days, 1,660 patients had died, and 1,861 died between days 31 and 365. The standardized absolute risk of death at both 0-30 and 31-365 days was lowest among patients in quartile 1 (0-30 days: 2.8%, 31-365 days: 4.1%) and highest among patients in quartile 4 (0-30 days: 9.7%, 31-365 days: 9.5%). The standardized relative risks of death increased in a stepwise fashion from quartile 2 to quartile 4 when using quartile 1 as the comparator. Similar findings were observed for heart failure.
Conclusion:
Among patients with myocardial infarction, higher CRP concentrations were significantly associated with a higher risk of death and incident heart failure.
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